Infective endocarditis is an inflammatory process of the endocardium, especially the heart valves. It carries high morbidity and mortality risks but outcomes can be improved with early diagnosis and effective treatment. The disorder is usually caused by bacterial infections entering the bloodstream from procedures involving the mouth, respiratory, gastrointestinal, or genitourinary systems. Symptoms include fever, heart murmur, and embolic complications. Diagnosis involves blood cultures, echocardiogram, and assessing for clinical signs. Treatment consists of intravenous antibiotics for 4-6 weeks along with managing complications and preventing recurrence.

1. I N F L A M M ATO R Y
D I S O R D E R S O F T H E H E A R T

2. INFECTIOUS DISEASES OF THE HEART
• Any of the heart's three layers may be
affected by an infectious process.
• The diseases are named for the layer of
the heart most involved in the infectious
process: (Myocarditis (inflammation of
myocardium)

3. • Endocarditis(inflammation of the endocardium) and
pericardium(inflammation of the pericardium)
• The usual management for all infectious diseases
prevention. IV antibiotics are usually necessary
once an infection in the heart has developed.

4. COMMON INFLAMMATORY DISEASES
OF THE HEART
• Infective Endocarditis
• Acute pericarditis
• Myocarditis
• Rheumatic fever and Herat disease

5. INEFFECTIVE ENDOCARDITIS
•

6. INTRODUCTION
• Endocarditis is an inflammation of the endocardium; it
is usually limited to the membrane lining and the valves.
• Theca use of endocarditis may be viral, fungal, or most
commonly, bacterial.
• The most common organism is Streptococcus viridans.
Vegetations (growths orlesion) may cause vulvular
dysfunction.

7. INEFFECTIVE ENDOCARDITIS
• Endocarditis is inflammatory process of
the endocardium, especially the valves.
• This disorders carriers high morbidity
mortality rates, but outcomes can be
improved greatly with early diagnosis
effective treatment.

8. INEFFECTIVE ENDOCARDITIS

9. ETIOPATHOPHYSILOGY
• Common injecting organisms include:
1. Staphylococci (s. aureus, S.faecalis,
S.epidermidis)
2. Streptococci
3. Escherichia coli
4. Gram negative organisms (klebsiella,
pseudomonas,)
5. Fungi (Candida,aspergillus) and HACEK
organisms.

10. HACEK
•The acronym HACEK refers to a group of
fastidious gram-negative coccobacillary
organisms.
• HACEK stand
for Haemophilus species, Aggregatibacter species,
Cardiobacterium hominis, Eikenella corrodens,
and Kingella species.

12. CONTI.....
• These organisms enter the body through
the oral cavity after dental procedures,
mouth or tooth abscesses, oral irrigations,
or irritations from dental floss or bridge
work.

13. CONTI...
• The upper respiratory tract is another port of
entry following surgery, intubations, or
• Direct exposure of the bloodstream to
can occur with prolonged IV catheters,
haemodialysis catheters and IV drug use.

14. CONTI..
• Procedures involving the gastrointestinal
and geneto - urinary tract(barium enemas,
sigmoidoscopy, colonoscopy, liver biopsy
and prostatectomy) have been associated
with infective endocarditis.

15. PREDISPOSING RISK FACTORS OF
ENDOCARDITIS
Congenital heart defects
Damaged valves by rheumatic fever, atherosclerosis
Artificial heart valves
May occur after cardiac surgery, invasive procedures (dental
procedures, catheterization, prolonged IV therapy) minor
surgery, gynecologic examinations, dialysis.
May follow after acute infection of the tonsils, gums, teeth,
skin, lungs, GIT, GUT
Immunocompromised patients
 I.V Drug abusers (injections)

16. PATHOPHYSIOLOGY
Organism travels in the
blood stream
forms vegetations
(clumps of bacteria,
fibrin, cellular debris,
platelets)
growth of vegetation on heart
valves
attaches to the
endocardial lining
of a normal heart
or an area of
defect (heart
valves)
Emboli that can lodge to various
organs (kidney, coronary artery,
spleen, lungs, brain)
deforms, thicken, stiffen,
perforate the valve leaflets
infected clots may break free and
travel through the bloodstream
Dysfunctional heart valves
obstruct blood flow and produce
organ damage

17. CLINICAL MANIFESTATIONS
• The primary presenting symptoms of infective
endocarditis are fever and a heart murmur.
• Clinical manifestations related to the infection
include
• Fever ,chills, alternating with sweats, malaise,
weakness, anorexia, weight loss, pallor, backache
and spleenomegaly.

18. CLINICAL MANIFESTATIONS RELATED TO
EMBOLIZATION OCCURS IN ANY PART OF THE BODY
• Stroke, TIA, aphasia
• Loss of vision form embolization to the brain or
retinal artery
• Roth’s spots
• Myocardial infarction
• Pulmonary embolism
• Splinter haemorrhage
• Clubbing of the fingers

19. Osler’s nodes (red, painful nodes with a white center
on the pads of fingers, toes, palms or soles) – a late
sign of infection.
•Osler's nodes are painful, red, raised lesions
found on the hands and feet.
•They are associated with a number of
conditions, including infective endocarditis, and
are caused by immune complex deposition.

20. OSLER’S NODES

21. ROTH’S SPOTS

22. CLUBBING OF THE FINGERS & CLUBBING OF
THE FINGERS

23. ASSESSMENT AND DIAGNOSTIC TESTS
• History collection
• Physical examination
• WBC
• Echocardiography
• ESR
• Blood culture

24. COMPLICATIONS
• Heart failure
• Cerebral vascular complications
• CHF - most common, due to damage to the
aortic, mitral valve
 Embolic episodes – ischemia and necrosis of
organs.
 arrhythmias – atrial fibrillation
 Glomerulonephritis.
 Stroke ( CVA)
 Brain abscess

25. PREVENTION
• Antibiotics prophylaxis is recommended for moderate
and high risk patients is recommended before and
sometimes after the following procedures.
1. Dental procedures.
2. Tonsillectomy and adenoidectomy.
3. Surgical procedures that mainly intstinaland
respiratory.
4. Bronchoscopy.
5. Fall bladder surgery.
6. Urethral cacatheterisation.
7. Urinary tract and prostatic surgery.

26. PREVENTIONS
•Prophylactic antibiotics are often given to people
with predisposing heart conditions before dental
procedures or surgeries involving the respiratory,
urinary, or intestinal tract.

27. MEDICAL MANAGEMENT
• The objective of management to eradicate
the infecting organisms through adequate
doses of an appropriate antimicrobial
therapy and to treatment complications.

28. CONTI...
• The choice of antibiotics therapy
depends on the types of organisms
involved.
• Penicillin and gentamicin commonly
• Therapy should administer at least 4 to
weeks

29. MEDICAL MANAGEMENT
1. Identify the infectious organism - serial blood cultures
• 2. Destroy the infectious org., stop the growth of Valvular
vegetations.
 IV Antibiotics 4-6 weeks (Penicillin, Aminoglycosides)
- to ensure high blood levels of medication
- to eradicate the bacteria from the chambers
& valves
 repeated blood cultures are done to assess
effectiveness of the drug.

30. MEDICAL MANAGEMENT
•3. Surgical repair of valvular deformities and
congenital defects.
•4. Provide nutritional supplementation & bed
rest.
•5. Prevent relapse and recurrent fever &
infection.

31. NURSING MANAGEMENT
 Provide comfort measures,  fever
 Encourage adequate fluids & nutrition
 CBR if w/ signs of valve dysfunctions
(murmurs)
 Assess for signs of heart failure, tachycardia,
embolic manifestation.
 Provide health teachings: cause of infection,
prolonged use of antibiotic, prophylactic
antibiotics,
preventing recurrence of infection (good oral

32. NURSING INTERVENTIONS
• Watch for signs and symptoms of embolization such as
hematuria, pleuritic chest pain, left upper quadrant pain,
and paresis.
• Monitor the patient’s renal status including blood urea
nitrogen levels, creatinine clearance levels and urine
output.
• Assess cardiovascular status frequently and watch for
signs of left ventricular failure such as dyspnea,
hypotension, tachycardia, tachypnea, crackles, neck vein
distention, edema, and weight gain.
• Check for changes in cardiac rhythm or conduction.
• Evaluate arterial blood gas values as needed to ensure
adequate oxygenation.

33. NURSING INTERVENTIONS
• Observe for signs of infiltration or inflammation at the
venipuncture site.
• Stress the importance of taking the medication and
restricting activities for as long as the doctor orders.
• Tell patient to watch closely for fever, anorexia, and other
signs of relapse for about 2 weeks after treatment stops.
• Teach the patient how to recognize symptoms of
endocarditis, and tell him to notify the doctor
immediately if such symptoms occur.
• Stress the importance of dental hygiene to prevent caries and
possible recurrent endocarditis.